Page 13 - Optima Tax EE Guide 01-19 CA_FINAL

Prescription Drugs

The Blue Shield medical plans include prescription drug coverage for you and your covered dependents.

Retail Pharmacy
Use a retail pharmacy to fill prescriptions for acute conditions (conditions that do not
require the medication to be taken on a regular basis). At a participating pharmacy, you
will receive up to a 30 day supply of your prescriptions.

Mail Order Pharmacy – Maintenance Medication
You could pay less for the same medication when you use the mail order pharmacy. Blue
Shield has partnered with Spectrum to provide our mail order drug program.

The mail order pharmacy is a fast, easy and convenient way to save time and money on
your maintenance medications (drugs that you need to take regularly). You can order
additional supplies of medication at a discount. See below for details!

Blue Shield Blue Shield Blue Shield Blue Shield
Plan Name Trio HMO Access+ HMO PPO High PPO Low
Deductible $0 $0 $0 $0 $0 $0
Retail Pharmacy
Tier 1a / 1b $15 $15 $10 $10 + 25% $15 / $20 $15 + 25%
Tier 2 $30 $30 $25 $25 + 25% $30 / $40 $30 + 25%
Tier 3 $45 $45 $40 $40 + 25% $45 / $60 $45 + 25%
Supply Limit 30 Days 30 Days 30 Days N/A 30 Days N/A
Mail Order Pharmacy
Tier 1 $30 $30 $20 Not $30 Not
Tier 2 $60 $60 $50 Covered $60 Covered
Tier 3 $90 $90 $80 $90
Supply Limit 90 Days 90 Days 90 Days N/A 90 Days N/A
Specialty - Retail & Mail Order
20% Max
30% Max
Not
30% Max
Specialty $200 Copay $200 Copay $200 Copay Covered $200 Copay Covered
20% Max
Not
Supply Limit 30 Days 30 Days 30 Days N/A 30 Days N/A
Pharmacy Tips

Use generic and over the counter drugs when available.
The best way to save on prescriptions is to use generic or over the counter
medications as opposed to brand name drugs. Generic drugs must use the same
active ingredients as the brand name version of the drug. A generic drug must
also meet the same quality and safety standards.

Use the mail order benefit for maintenance medications
To save money and time, consider using the mail order pharmacy to fill your
maintenance medications.

Employee Benefits 13